| NPI | 1821353004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL PN5226139) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 226086) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2017-05-29 |